The New Health Care: Consumers bracing for new world of insurance

Monday

Sep 30, 2013 at 2:00 AM

For Beth Roeper, disabled with multiple sclerosis and paying $700 a month to keep the health insurance her former employer had provided, the onset of Obamacare this week likely means significantly cheaper coverage.

Chris McKenna

For Beth Roeper, disabled with multiple sclerosis and paying $700 a month to keep the health insurance her former employer had provided, the onset of Obamacare this week likely means significantly cheaper coverage.

She recently learned that a comparable plan being offered by the same insurer through the New York state-run health insurance exchange that opens for enrollment on Tuesday costs about half as much, not including any subsidy the federal government kicks in.

But the Washingtonville woman must resolve at least one major concern before switching plans: how much the new policy would require her to pay for one of her medications, which costs more than $4,000 a month. Higher drug costs, she points out, might wipe out any premium savings.

"I definitely have to research the specific medications," she said.

For Roeper and other mid-Hudson residents venturing into the new insurance market, a host of variables will determine whether the new options made available through the 2010 Affordable Care Act are truly affordable. Premiums vary widely, depending on the insurer and level of coverage, and so do the size of government subsidies, which are based on the buyer's income.

In Orange, Ulster and Sullivan counties, shoppers can choose from among five to seven insurers, each offering five levels of coverage (platinum, gold, silver, bronze and catastrophic). Higher levels such as platinum and gold mean higher premiums but lower deductibles and co-payments.

Prospective buyers, who will be allowed to enroll in plans online starting Tuesday, can start by surveying their options with a tool offered through the exchange website (nystateofhealth.ny.gov). The program lets shoppers see which plans are available where they live, the prices and the subsidies they would get.

Take a Middletown family of four, earning $60,000 a year. If they opt for medium-ranked silver coverage, seven policies are offered at monthly prices ranging from $661 to $1,036. According to the state's estimating program, the government would kick in $251 a month through tax credits, leaving the family with monthly payments of $410 to $785.

That's a fraction of what the same family previously would have paid with New York's prices. As of August, the cheapest family HMO policy in Orange County cost $3,235 a month.

For uninsured New Yorkers priced out of that market, the coverage offered through the new exchange is vastly cheaper. But costs may rise for those with lower incomes enrolled in the state-subsidized Healthy New York program, which will be phased out under Obamacare.

Exchange prices are higher than Healthy New York premiums. But federal subsidies will narrow the price gap, blunting the impact for Healthy New York customers making the transition to exchange plans, says Larry Johnson, a vice president at the Newburgh-based William A. Smith & Son insurance agency.

Johnson also pointed out that exchange policies must cover medical expenses that Healthy New York doesn't, including pediatric dental and vision care, ambulance service and chiropractic care.

Insurance costs became a pressing concern for Roeper in February, when she left her job as director of health services at Mount Saint Mary College in Newburgh because her multiple sclerosis had become too debilitating. Medical coverage that cost her $84 a month as an employee now cost $700 a month through COBRA.

That's a large expense for Roeper, who's living on $1,900 a month in Social Security disability payments. She hopes to boost her income with long-term disability, but says she first must overcome resistance by Mount Saint Mary's insurer.

While discussing the health-insurance options and decisions that lie ahead, Roeper recalled following the complicated debate over the Affordable Care Act from a very different vantage point, before she joined the ranks of those it was intended to help.

"It was all very esoteric, and now it's become very personal," she said.

-- Reporter James Walsh contributed to this story.

cmckenna@th-record.com

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